Isolated sphenoid sinus pathologies: a series of 40 cases

Background/aim: Isolated sphenoid sinus-derived lesions are rare and generally present with unclear symptoms. We are sharing our experience to be mindful of such lesions in differential diagnosis and to help accomplish successful treatment while avoiding revisions and complications.Materials and methods: Data from patients who underwent isolated sphenoid sinus surgeries (ISSs) were retrospectively extracted from the period of January 2005 to August 2015. Demographic data, chief complaints and presenting symptoms, imaging findings, surgical management, and results were evaluated. Results: There were 40 patients who underwent ISS. These patients had different pathologies. The chief complaint was nonspecific headache, except for cerebrospinal fluid leak patients who presented with serous rhinorrhea. Conclusion: It is critical to investigate suspicious symptoms with clinical findings and imaging techniques to avoid late diagnoses of isolated sphenoid pathologies. The transnasal approach is more minimally invasive and tissue-sparing. In our experience, we have noted that excising the inferior one-third of the superior turbinate decreases revisions. On the other hand, results show that the presence of concomitant pathology and invasive fungal disease increases the risk of revision surgery and complications.

Microbiological and Histopathological Effects of Nasal Packing Containing Probiotics on Nasal Mucosa.

BACKGROUND: Nasal packing is frequently used after surgical interventions to prevent bleeding and synecchia formation and for the treatment of diseases such as epistaxis. One of the most morbid complications of nasal packing applications is the toxic shock syndrome (TSS). Owing to the microbiological structure of nasal mucosa, antibiotics are administered to all patients who are applied nasal packages for prevention of TSS. AIM: The aim of this study is the evaluation of microbiological and histopathological changes taking place in nasal mucosa with nasal packing containing probiotics. METHODS: Three groups were formed with 6 rats in each group. The nasal packings with the same characteristics were applied to nasal cavities of rats in all 3 groups. In group 1, only nasal packs were used. Probiotics or parenteral antibiotics were not used. In group 2, parenteral antibiotics were used along with nasal packs. In group 3, nasal packs with probiotics containing Lactobacillus strains were applied. No parenteral antibiotics were used. After 3 days packages were removed and nasal cavity was irrigated with saline. Both packages and irrigation materials were analyzed for microbiological content. After scarification, nasal and paranasal structures were examined for histopathological changes. RESULTS: In group 3 statistically the total bacteria load was significantly lower in comparison to the other groups. However, in the histopathological evaluation of the mucosa of rats in group 3, bleeding and inflammation findings were significantly higher statistically. CONCLUSIONS: It has been determined that the total microbiological load significantly decreases with the application of packing containing probiotics. So, the use of probiotics along with nasal packings is promising to prevent unnecessary use of medications.

Laryngeal Chondroma: An Unusual Complication Endotracheal Entubation.

INTRODUCTION: Laryngeal cartilaginous framework tumors are very rare. Chondroma and chondrosarcoma are the most common types of these tumors. PATIENT PRESENTATION: A 27-year-old man with a history of intubation presented with exercise-induced dyspnea. A computed tomography scan of larynx showed a rounded and circumscribed mass without infiltration of the adjacent structures which obstructs 75% of airway. Histopathological investigation of the mass revealed the chondroma of the larynx. The patients' history of intubation trauma with the subsequent progressive onset of clinical symptoms demonstrates the relationship between these 2 entities. CONCLUSION: Clinicians should consider laryngeal chondroma in the differential diagnosis of dyspnea after endotracheal intubation.

Clinical Characteristics of Recurrent Juvenile Nasopharyngeal Angiofibroma (JNA) After Radiation Therapy.

Juvenile nasopharyngeal angiofibroma (JNA) is a benign vascular tumor occurring in young males. Treatment of JNA is a complex procedure, especially in advanced cases with a high risk of major complications. We report the clinical, radiological and histological specialties of a rare case of recurrent JNA 3 years after radiation therapy in an 18-year-old boy. The patient underwent endoscopy assisted partial midfacial degloving approach. This treatment has been shown to be effective in advanced JNAs with minor morbidity.

An unusual mass of nasal cavity: recurrent glomangiopericytoma.

Hemangiopericytomas are rare tumors of sinonasal region. In this article, we described a case of recurrent mass in right nasal cavity which presented with nasal obstruction and intermittent epistaxis. Patient had a surgical history on the same nasal region without any histopathological document. Abnormal bleeding was observed during surgery and mass was partially removed for histopathological investigation. The result was glomangiopericytoma of the sinonasal region. Although extended surgery was recommended to the patient including preoperative and perioperative measures for bleeding problem, patient preferred to follow-up rather than removal. The clinical progress and review of glomangiopericytoma have also been discussed.

Halitosis in otorhinolaryngology practice.

Halitosis is a common and devastating condition, which may affect up to 1/3 of the population. It can be classified either as genuine halitosis, pseudohalitosis, or halitophobia. Genuine halitosis is more common and usually related to an organic pathology such as periodontitis. Malodour molecules such as sulfur compounds that arise from bacterial interactions generate the basis of oral malodour. Pathologies of the tongue, poor oral hygiene, deep caries, cryptic tonsillary hypertrophia, and postnasal drainage are also associated with halitosis. Gastro-esophageal pathologies and systemic problems are accepted as extra-oral sources of halitosis. There are various methods for the diagnosis of halitosis including objective and subjective methods. General oral hygiene recommendations and specific interventions for the related etiological factors have to be addressed in order to achieve satisfactory results after the treatment. Clinicians have to be aware of these aspects regarding this unfavorable condition to achieve the best results.

Lateral skull base destruction: unusual clinical progress of lymphoma.

Lymphoma is a common tumor especially in pediatric population. It can originate every lymphoid tissue in the head and neck region. Head and neck lymphomas usually present with a slow-growing mass. We encountered a man who had a lymphoma that destroyed all soft tissues of the left lateral skull base. The unusual clinical progress is discussed in the article.

Analysis of choanal polyps.

Choanal polyps (CPs) are unilateral benign masses usually originating from paranasal sinuses. Maxillary, ethmoid, and sphenoid sinuses are involved in order of decreasing frequency. In this study, the medical records of patients operated on with a clinical diagnosis of CP between 1998 and 2011 were reviewed. A total of 98 patients with a mean age 24.3 years were analyzed. Histopathologic diagnoses were CP in 94 patients and inverted papilloma in 4 patients. The sites of origin were maxillary sinus in 89 patients (90.8%), sphenoid sinus in 6 patients (6.1%), bulla ethmoidalis, inferior concha, and uncinate process in 1 patient each (1.0%). The most common symptoms were nasal obstruction (98.0%) and postnasal drip (30.6%). The surgical approaches were endoscopic sinus surgery in 63 patients (62.4%) unilaterally and in 12 patients (11.9%) bilaterally and unilateral endoscopic sinus surgery with mini Caldwell in 26 patients (25.7%). All 3 recurrences were in pediatric patients, and the recurrence rates among pediatric patients and overall were 7.7% and 3.1%, respectively. Endoscopic sinus surgery is an effective surgical procedure for treatment of CP; however, addition of a mini-Caldwell approach is safe for antrochoanal polyp resection if the endonasal technique fails. Histopathologic examination is mandatory because inverted papillomas may present as CPs.

Sphenopalatine artery pseudoaneurysm: a rare cause of intractable epistaxis after endoscopic sinus surgery.

Epistaxis is a frequent health problem and the most common cause of emergency in otorhinolaryngology practice. In this report, a case of a 26-year-old patient with intractable epistaxis after endoscopic sinus surgery was presented. The epistaxis began at the fourth postoperative day and was unresponsive to endoscopic cauterization and anterior and posterior nasal packing. On angiographic investigation, a pseudoaneurysm of the sphenopalatine artery was detected and treated with microcatheter embolization. This is the second case of postoperative sphenopalatine pseudoaneurysm as a complication of endoscopic sinus surgery in the literature.

Non-steroidal anti-inflammatory drug-activated gene-1 expression levels in nasal polyposis.

OBJECTIVES: This study aims to investigate the possible role of non-steroidal anti-inflammatory drug-activated gene-1 (NAG-1) in nasal polyp development. PATIENTS AND METHODS: Twenty-one patients (15 males, 6 females; mean age 44.3 years; range 16 to 65 years) who underwent endoscopic sinus surgery for nasal polyposis (NP) were included in the study. Inferior turbinate mucosa samples were taken in addition to the polyp tissue which was already removed during routine procedure. The NAG-1 gene messenger ribonucleic acid (mRNA) expression levels of the polyp tissue and healthy turbinate mucosa were examined by real-time polymerase chain reaction (PCR). Patients were divided into two groups based on the presence or absence of comorbid asthma. RESULTS: The NAG-1 gene expression of the polyp tissue was 1,089 fold higher, compared to the healthy nasal mucosa (p=0.757). The NAG-1 mRNA levels were 2.13 times decreased in the patients with comorbid asthma (p=0.275). There was no statistically significant difference between the groups. CONCLUSION: With the findings of this study NAG-1 gene may play a role in nasal polyp development in the presence of comorbid asthma.

[The role of COX-2, ALOX12 and iNOS genes in nasal polyposis]. / COX-2, ALOX12 ve iNOS genlerinin nazal polipozisteki rolü

OBJECTIVES: The aim of this study was to investigate whether cyclooxygenase-2 (COX-2), arachidonate 12-lipoxygenase (ALOX12) and inducible nitric oxide synthase (iNOS) which are well-known mediators in inflammatory process play a role in nasal polyposis (NP) and to show their roles in initiation and progression of inflammation. PATIENTS AND METHODS: We investigated the expression levels of COX-2, ALOX12 and iNOS genes by real-time polymerase chain reaction (PCR) method in NP tissues obtained from 10 patients (4 females, 6 males; mean age ?? years; range 21 to 54 years). RESULTS: The mRNA levels of COX-2 expression observed in NP was found to be relatively increased, compared to the control tissue (p>0.05). The ALOX12 levels were relatively decreased (p>0.05), while the expression level of iNOS mRNA was significantly higher in NP tissue (p<0.05). CONCLUSION: These data suggest that nitric oxide (NO), a gene product of iNOS, may play a physiological role in the upper airways and also NO is associated with inflammatory processes in the airways.

[Co-existence of nasopharyngeal carcinoma and sinonasal paraganglioma: a case report]. / Nazofarenks karsinomuyla es zamanli sinonazal paragangliyom: Olgu sunumu.

Paragangliomas are very rarely seen in the nose, paranasal sinuses and nasopharynx. The development of paraganglioma concurrently with nasopharyngeal carcinoma in the same region has not been reported to date. In this study we reported a 59-years-old a female case of nasopharyngeal carcinoma who underwent radiotherapy six years ago and got the diagnosis of sinonasal paraganglioma in the same region during follow-up and underwent nasal endoscopic excision.

Efficacy and tolerability of systemic methylprednisolone in children and adolescents with chronic rhinosinusitis: a double-blind, placebo-controlled randomized trial.

BACKGROUND: The place of systemic corticosteroids in the treatment of children with chronic rhinosinusitis (CRS) remains unclear. OBJECTIVE: We sought to assess the effectiveness and tolerability of oral methylprednisolone as an anti-inflammatory adjunct in the treatment of CRS in children. METHODS: Forty-eight children (age, 6-17 years) with clinically and radiologically proved CRS were included. Patients were randomly assigned to either oral amoxicillin/clavulanate (AMX/C) and methylprednisolone or AMX/C and placebo twice daily for 30 days. Oral methylprednisolone was administered for the first 15 days with a tapering schedule. Primary parameters were mean change in symptom and sinus computed tomographic (CT) scan scores after treatment. Secondary study parameters were mean changes in individual symptom scores after treatment, relapse rate, and tolerability. RESULTS: Forty-five patients completed the study: 22 received AMX/C and methylprednisolone, and 23 received AMX/C and placebo. Both groups demonstrated significant improvements in symptom and sinus CT scores when comparing baseline values with end-of-treatment values (P < .001). Methylprednisolone as an adjunct was significantly more effective than placebo in reducing CT scores (P = .004), total rhinosinusitis symptoms (P = .001), and individual symptoms of nasal obstruction (P = .001), postnasal discharge (P = .007), and cough (P = .009). At the end of treatment, 48% of the children in the placebo group still had abnormal findings on CT scans versus 14% in the methylprednisolone group (P = .013). Therapy-related adverse events were not different between groups. Although insignificant, the incidence of clinical relapses was also less in the methylprednisolone group (25%) compared with that in the placebo group (43%, P = .137). CONCLUSION: Oral methylprednisolone is well tolerated and provides added benefit to treatment with antibiotics for children with CRS.

[Use of dehydrated temporal fascia in chronic otitis media surgery and tympanoplasty]. / Kronik otit cerrahisi ve timpanoplastide dehidrate temporal fasya kullanilmasi.

OBJECTIVES: We evaluated the use of homograft dehydrated temporal fascia (Tutoplast) in repair of tympanic membrane perforations secondary to chronic otitis media. PATIENTS AND METHODS: Dehydrated temporal fascia was used during tympanoplasty in 17 patients (10 females, 7 males; mean age 34 years; range 15 to 53 years) with chronic otitis media. Operations were type 1 tympanoplasty in six patients, tympanoplasty and mastoidectomy in three patients, and revision tympanoplasty and/or mastoidectomy in the remaining patients. The patients were followed-up for at least two years. RESULTS: Complete wound healing was achieved without complications, and the material used was well tolerated in all the patients. Only one patient had a small perforation. The tympanic membranes were anatomically intact in 16 patients (94%). CONCLUSION: The use of dehydrated temporal fascia provides maximum microsurgical comfort due to its soft, flexible feature and maintenance of its delicacy even in contact with blood. Thus, dehydrated temporal fascia should be considered for selected cases for its ease of use and anatomical success.

[Hemodynamic effects of local anesthetics with adrenaline during septal surgery]. / Nazal cerrahide adrenalinli lokal anestetiklerin hemodinamik etkileri.

OBJECTIVES: We investigated the hemodynamic effects of local anesthetics with adrenaline used before septal surgery. PATIENTS AND METHODS: In a prospective, controlled design, administration of local anesthetics was performed with and without adrenaline in 39 patients and 10 patients, respectively, undergoing septal surgery. Plasma adrenaline concentrations were measured before anesthesia, and after 2, 5, and 10 minutes from anesthesia. The patients were monitored with respect to pulse rate, electrocardiographic findings, and blood pressure. RESULTS: Preoperative plasma adrenaline levels were similar in patients receiving local anesthetics with or without adrenaline (0.8 nmol/l vs 0.7 nmol/l). Following adrenaline administration, adrenaline levels showed significant increases to 2.2, 1.9, and 1.7 nmol/l after 2, 5, and 10 minutes, respectively (p<0.001), whereas they remained similar in the control group. No side effects related to adrenaline use were detected. CONCLUSION: Despite systemic absorption of local injections, adrenaline-related side effects during septal surgery are extremely rare when the patients are closely monitored.

Upper lateral cartilage inner mucoperichondrial flap technique for the repair of nasal septal perforation.

Treatment of nasal septal perforations which decrease quality of life is a surgical challenge with variable success rates. Numerous surgical methods have been proposed for closure of perforations. The technique described in this article, i.e. closure of the perforation with an upper lateral cartilage mucoperichondrial flap through an external septorhinoplasty approach, is an alternative surgical technique. Twenty-four patients with symptomatic nasal septal perforation were operated on using this technique and followed up for a mean duration of 28 months. Preoperative and postoperative symptom scores for crusting, nasal obstruction, bleeding, discharge, whistling, headache, nasal pain, snoring and olfactory loss as well as overall discomfort levels were compared using a visual analogue scale. Complete closure of the perforation was achieved in 19 patients.

Association of GABA(B)R1 receptor gene polymorphism with obstructive sleep apnea syndrome.

OBJECTIVE: GABA(B)R (gamma-amino butyric acid B receptor)-mediated neurotransmission has been implicated in the pathophysiology of a variety of neuropsychiatric disorders. GABA(B)R1 gene variants were identified by single-strand conformation analysis. The nucleotide exchanges cause a substitution of alanine to valine in exon 1a1 (Ala20Val), a substitution of glycine to serine in exon 7 (Gly489Ser) and a silent C to G nucleotide exchange encoding the amino acid phenylalanine in exon 11 (Phe658Phe). The significance of GABA(B)R1a gene polymorphism in obstructive sleep apnea syndrome (OSAS) as well as the association of these polymorphisms with the polysomnography findings in OSAS patients are not known. In this study, we aimed to assess the significance of 3 different GABA(B)R1 gene polymorphisms (Ala20Val, Gly489Ser and Phe658Phe) in OSAS. METHODS: Seventy-five patients (23 female and 52 male) with OSAS and 99 healthy volunteers (51 female, 48 male) were included in the study to assess Ala20Val, Gly489Ser and Phe658Phe polymorphisms of the GABA(B)R1 gene. RESULTS: For the Ala20Val variants, there was no significant difference between the genotypes and allele frequencies of the patients and controls, nor between both genders (p > 0.05). For Phe658Phe polymorphism, there was no significant difference between genotypes and allele frequencies of the patients and controls (p > 0.05). However, the C/C genotype was overrepresented and the T/C genotype was less frequent in male than female patients (p = 0.03). The C/C genotype was overrepresented and the T/C genotype was less frequent in male patients than male controls (p = 0.01). For GABA(B)R1-Gly489Ser polymorphism, all of the patients and controls had G/G genotype. The apnea arousal index scores of the male patients with C/C genotype were significantly higher than in the patients with C/T genotype (p = 0.01). The percent total sleep time in non-REM 1 scores of the male patients with T/T genotype were significantly higher than in the patients with T/C genotype (p = 0.021). The percent total sleep time in non-REM 2 scores of the female patients with C/C genotype were significantly higher than in the patients with C/T genotype (p = 0.006). CONCLUSION: The Ala20Val polymorphism of the GABA(B)R1 gene may be associated with OSAS, whereas Gly489Ser polymorphism does not seem to be involved in OSAS. The C/C variant of the Phe658Phe polymorphism GABA(B)R1 gene seems associated with the occurrence of OSAS and is also associated with some sleep related parameters (apnea arousal index and percent total sleep time in non-REM) recorded by polysomnography.

[Endoscopic surgery of sphenochoanal polyp]. / Sfenokoanal polibin endoskopik cerrahisi.

Sphenochoanal polyp is a rare entity originating from the sphenoid sinus. It may be confused with an antrochoanal polyp on anterior rhinoscopy. Computerized tomography and nasal endoscopy have contributed to an increase of accuracy in the diagnosis of these masses. Simple polypectomy that leaves some part of the polyp inside the sphenoid sinus carries a high risk of recurrence. We present a case of sphenochoanal polyp in a child that was operated by endonasal endoscopic approach. She was free of symptoms after surgery. No complications and recurrences were observed at 16 months of follow-up periods respectively.

[Isolated inverted papilloma of the sphenoid sinus: a case report]. / Sfenoid sinüsün izole inverted papillomu: olgu sunumu.

Inverted papilloma is a rare benign sinonasal tumor characterized by a potentially invasive nature. The lateral nasal wall represents the most common site of origin, whereas paranasal sinuses are frequently involved by extension. In contrast, primary sinus inverted papillomas have rarely been reported. The present study describes a 52-year-old man that presented with a one-year history of unilateral nasal obstruction, nasal discharge, epistaxis, occipital headache and decreased sense of smell. After nasal endoscopic examination, computed tomography was taken and endoscopic biopsy was performed which demonstrated isolated inverted papilloma of the left sphenoid sinus. Tumor was taken via transnasal endoscopic sphenoidotomy. No evidence for recurrent disease was seen after 12 months of follow-up and his symptoms were completely relieved. Endoscopic transnasal sphenoidotomy remains an effective treatment for these lesions.

Thymic and adenotonsillar enlargement after successful treatment of malignancies.

Anterior mediastinal and adenoid masses in children after cessation of chemotherapy for malignant disease often cause a diagnostic problem. Differential diagnosis of thymic enlargement and adenoid hyperplasia from recurrence frequently poses a challenge both for the radiologist and the physician. In this study the authors evaluated 491 patients with different malignant tumors for thymic and adenoid hyperplasia. Thymic hyperplasia was seen in 18 patients (5 Hodgkin disease (HD), 5 non-Hodgkin lymphoma (NHL), 4 Wilms tumor, 2 germ cell tumor, 1 Ewing sarcoma, and 1 neuroblastoma), only adenotonsillar hyperplasia was seen in 6 patients, all with NHL, and both thymic and adenotonsillar hyperplasia were seen in 3 patients (1 HD, 2 NHL). In 5 patients, adenoid hyperplasia was proven by biopsy; 1 patient underwent to adenoidectomy. Their histopathologic investigation showed polyclonal follicular hyperplasia. The authors recommend that patients with thymic and/or adenotonsillar enlargement after successful treatment of their primary malignancy should be evaluated cautiously before an invasive procedure is planned.